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Published on: June 20, 2018
Comparing endoscopic resection and open resection for management of sinonasal mucosal melanoma
Nicole I Farber1, Richard D Bavier1, Meghan M Crippen1
1Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.
Background:
Sinonasal mucosal melanoma (SMM) is a rare, aggressive cancer, optimally managed with complete surgical resection. This study aimed to assess the impact of surgical approach on outcomes by comparison of cases managed with open vs endoscopic resection.
Methods:
The National Cancer Database 2010-2015 datasets were queried for all cases of non-metastatic SMM initially managed with definitive surgery. Patients were grouped according to surgical approach (open vs endoscopic) and compared for patient, tumor, and treatment variables using chi-square analyses. Case-control matching was used to generate subgroups of cases paired 1:1 between groups, matched for significantly distributed variables. Subgroups were compared for perioperative outcomes and overall survival (OS) using Kaplan-Meier analyses.
Results:
Of the 686 cases of SMM managed with definitive surgery, 46.2% were treated endoscopically. Open and endoscopic groups did not differ significantly by T-stage, primary site, or rates of adjuvant therapies. Case-control matching for these variables generated a subpopulation of 240 paired cases. Comparison of matched groups found no significant differences in 30-day or 90-day mortality. Endoscopically managed patients had higher rates of unplanned readmission whereas open resection patients had longer length of stay (LOS). There was no significant difference in OS between groups.
Conclusion:
In surgically managed SMM, open resection patients have significantly longer LOS, whereas endoscopic patients have higher rates of unplanned readmission. Surgical approach does not appear to influence OS.
Insights
Surgical approach for sinonasal mucosal melanoma (SMM) impacts hospital stay and readmissions but not overall survival. Open resection leads to longer hospital stays, while endoscopic resection has higher readmission rates.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Cancer Research
Background:
- Sinonasal mucosal melanoma (SMM) is a rare and aggressive malignancy.
- Complete surgical resection is the optimal management strategy for SMM.
Purpose of the Study:
- To compare the outcomes of open versus endoscopic surgical resection for SMM.
- To evaluate the impact of surgical approach on perioperative outcomes and overall survival.
Main Methods:
- Analysis of the National Cancer Database (2010-2015) for non-metastatic SMM treated with surgery.
- Comparison of open and endoscopic resection groups using chi-square and case-control matching.
- Assessment of perioperative outcomes and overall survival (OS) using Kaplan-Meier analysis.
Main Results:
- Of 686 SMM cases, 46.2% underwent endoscopic resection.
- Matched analysis of 240 cases showed no difference in mortality.
- Endoscopic resection was associated with higher unplanned readmissions; open resection with longer length of stay (LOS).
Conclusions:
- Surgical approach for SMM affects LOS and readmission rates but not overall survival.
- Both open and endoscopic resections are viable options for SMM management.
